Which Hepatitis is the Worst? Understanding Hepatitis

Hepatitis virus infection affects more than 300 million people of the world’s total population. It claims approximately 3,500 lives each day worldwide. Which hepatitis is the worst may be a question of interest when you wonder how each type of viral hepatitis differs from each other. Each of them differs in how they spread, severity of the infection, and long-term impact to the quality of life. As an overview, hepatitis A is the least worrisome of all since it resolves completely. Hepatitis B and C, on the other hand, can cause chronic infections leading to significant liver damage like cirrhosis resulting in increased risk for liver cancer

Key Takeaways

• Hepatitis C is generally considered as the “worst type of hepatitis”, which accounts for 75-85% of all chronic cases and the highest mortality rate in the United States

• Hepatitis B has the greatest global burden and with the most chronic carriers worldwide

• Presence of multiple cofactors like HIV infection or alcohol abuse increases the likelihood of hepatitis

• New treatments for hepatitis C have cure rates of more than 95%

• Vaccination can efficient at preventing both hepatitis A and B infections

Finding out that you have hepatitis will make you wonder, which hepatitis is the worst type or one that poses the biggest threat. Hepatitis infection is not a single entity. Rather, it is a family of virus-caused liver disease affecting millions worldwide. Understanding which type of hepatitis is the worst matters for prevention and accurate management.

The severity of hepatitis ranges from mild, acute (short-term) illness to long-term, lifetime conditions that may lead to liver failure or cancer. Different types of infection have different outcomes, treatments, and prevention methods. To help you better understand what is the worst hepatitis, you need to understand its prevalence, duration, and mortality.

What Are The Different Types of Hepatitis?

Viral hepatitis comes in five different types: A, B, C, D, and E. Each of these types have different property, including:

• Spread (transmission)

• Symptoms

• Outcomes

When comparing hepatitis C vs hepatitis B and other types, it’s important to understand each of their characteristics to determine what hepatitis is the worst.

Hepatitis A

Hepatitis A spreads through contaminated food and water (fecal-oral route). It occurs the most in areas where good sanitation is not practiced.

If you contract hepatitis A, your symptoms could be the following:

• Fatigue

• Loss of appetite

• Stomach pain

• Jaundice (yellow discoloration of the eyes and skin)

Fortunately, your body has a way of fighting off hepatitis A naturally. Unlike other types of hepatitis, it does not cause long-term infection. Some might even consider this as the “good hepatitis” (but as it is still an infection, this term doesn’t exist) because it does not persist for years.

There is also an effective vaccine for hepatitis A, which is the reason for severe outbreaks occurring less frequently.

Hepatitis B

Hepatitis B spreads through contact of infected blood and other body fluids (e.g. semen and vaginal fluids). Knowing this, it means you can contract the infection during sexual contact, sharing needles, or vertically from mother and child during childbirth.

When adults contract hepatitis B, the majority of these cases, about 95%, do not become infected for long-term. However, a high percentage of infants and about 30% of children (aged 1-5 years) remain infected chronically. This long-term infection could lead to liver damage and scarring or even increase your risk for cancer.

A vaccine is available to prevent hepatitis B infection. But if you have chronic hepatitis B infection already, medications can help control the virus, although they could not entirely eliminate the virus.

Hepatitis C

Hepatitis C is spread primarily through blood contact. Many people got the infection through blood transfusion before 1992 (when testing started), from sharing needles, or at times through sexual contact.

What makes hepatitis C extremely worrisome is that 55-85% of infected patients develop chronic infection. And, about 15-30% have increased risk of developing cirrhosis in the next two decades. When cirrhosis sets in, this raises the risk of liver cancer.

There is no vaccine effective against hepatitis C yet. However, newer treatments (like DAAs or direct-acting antivirals) cure >95% of cases with few side effects. 

Hepatitis D and E

Hepatitis D is an unusual virus because it can only infect people who have been infected with hepatitis B. It significantly worsens hepatitis B infection. It also spreads in the same way as hepatitis B does.

Hepatitis E virus has the same transmission as hepatitis A (fecal-oral) — through contaminated food and water. A lot of patients recover completely. But it is particularly dangerous for pregnant women. Nonetheless, it causes no chronic liver problems in healthy individuals.

How do hepatitis A, B, and C differ in terms of severity?

To determine which hepatitis is worst and which hepatitis is more dangerous we need to assess how likely each type of hepatitis leads to chronic problems, such as:

• Liver problems

• Liver cancer

• Death

Being able to compare these viruses through these parameters help determine the worst hepatitis.

Acute vs Chronic Infection for Each Type

Hepatitis A has always been the cause of short-term (acute) infection. Your body can fight it completely. It resolves within a few months. There is no illness called “chronic hepatitis A” infection.

Hepatitis B, on the other hand, becomes chronic in about 5-10% of healthy adults. Infants have a higher chance of developing chronic infection if without proper treatment.

Hepatitis C is most likely persistent in about 55-85% of people who have the infection. This makes it even harder to eliminate than hepatitis A or B.

Risk of Developing Cirrhosis for Each Type

Since hepatitis A causes short-term infection only, it does not cause liver cirrhosis (severe liver scarring).

With chronic hepatitis B infection, the risk of developing cirrhosis sits at approximately 20% if left untreated, especially in combination with hepatitis D infection.

For hepatitis C, the risk of developing cirrhosis increases to 15-30% within 20 years for chronic infection and left untreated. The tissue scarring occurs gradually but steadily as the virus continues to attack the liver.

Risk of Liver Cancer from Each Type

Hepatitis A does not cause liver cancer.

Hepatitis B and C poses a significant threat in developing liver cancer (HCC). Hepatitis B carries a relatively higher risk of liver cancer in comparison to hepatitis C. However, this depends on which locality you belong to. In the United States, more HCC is associated with Hepatitis C because of its increased prevalence there.

If with cirrhosis, both hepatitis B and C face the highest cancer risk, which is why early intervention is recommended.

Which Hepatitis Has the Highest Mortality Rate?

Death (mortality) rates help us understand what’s the worst hepatitis. Many people wonder, “is hepatitis fatal?” but the answer actually lies on what type. The mortality number is important because it tells the story of which is the worst hepatitis.

Hepatitis A rarely causes death. The mortality remains less than 1% because it remains self-limiting (meaning it resolves on its own even without treatment). However, fatality still occurs in the older population with pre-existing liver disease. Most people fully recover from hepatitis since there is no long-term liver damage. So this infection is less fatal than other hepatitis types.

Chronic hepatitis B remains the major cause of liver-related deaths worldwide. It has an overall US rate of 0.47 deaths per 100,000 population, which is from 2010 to 2019 only. The total number of deaths within the same period is around 17,483. This mortality rate worsens if hepatitis B is combined with either hepatitis C or D.

Hepatitis C-related chronic liver disease has a mortality rate that surpasses the number of deaths from hepatitis B-related chronic liver diseases (approximately 537,000 deaths versus 523,000, globally. All-cause deaths even among treated patients are still several times higher than the general population, particularly those with advanced liver disease. Because of this, hepatitis C is deemed to be the worst hepatitis.

Hepatitis D infection occurs only with hepatitis B and it could signal worsening progression. HDV-related deaths are extremely rare but with co-infection, it significantly increases mortality rates. In the US, HDV was listed as 0.1% of the deaths associated with hepatitis B.

Hepatitis E usually causes acute, self-limiting infection just like hepatitis A, thus with an extremely low death rate in the general population as well. However, this death rate will increase if it happens in pregnant women and immunocompromised individuals.

Is There a Cure for Hepatitis B and C?

Treatment options play a significant role in identifying the worst hepatitis type. Curable diseases generally cause more concern than those that cause long-term or permanent infection.

There is no current treatment to completely cure hepatitis B infection. However, certain antivirals play a role to manage and control the virus, such as:

• Pegylated interferons

• Nucleoside/nucleotide analog

These types of medications prevent the virus from replicating. Since the medications help in managing the infection, they help people lead normal lives and prevent liver damage. But these medications are for a lifetime, like maintenance.

For hepatitis C, the treatment has evolved for years. Newer drugs like direct-acting antiviral drugs (DDAs) have been able to offer cure in 95% of cases in just 8-12 weeks of oral medication therapy.

These treatments have fewer side effects and are effective for the majority of patients. This has been a tremendous improvement from previous treatments that had a lot of side effects and lower efficacy rates.

The ability to cure hepatitis C nowadays makes the infection less worrisome as it once was. But early detection and testing remains important.

How Can Hepatitis Be Prevented?

Prevention has always been central to any infection or any disease. It helps in improving the outcome of patients.

Are There Vaccines for Hepatitis A and B?

Yes, both hepatitis A and B have safe, effective vaccines that have been rolled out for prevention of these infections. It was shown that nearly 83% of children under the age of 5 years old have received three doses of hepatitis B vaccine, with at least 90% receiving one dose.

Everyone should be vaccinated with hepatitis A and B virus, particularly the following:

• People who are traveling, especially to regions with endemic cases

• All children

• People who had underlying chronic liver disease

• Men who had sex with men

• Healthcare workers

• People who inject drugs

The vaccines offer long-lasting protection. And since its advent, it has reduced new infections.

How Can Hepatitis C Virus Be Prevented if There is No Vaccine?

Since there is still no existing vaccine for hepatitis C, the prevention is focused on avoiding contaminated body fluids like blood. Important strategies include:

• Not sharing needles, syringes, or drug equipment

• Ensuring tattoo and piercing shops follow sterilization protocols

• Practice safe sex by using condom, particularly those with multiple partners

• Healthcare workers should follow safety guidelines

Blood bank screening strategies have also improved through time. It has made safe transfusions possible since 1992. Treatment of infected people has been central to prevent spreading the infection to others.

What Are the Long-Term Effects of Chronic Hepatitis?

The long-term effects of chronic hepatitis are important to evaluate, particularly when identifying which hepatitis is the worst.

Hepatitis B and C infections can lead to serious long-term effects. The risk of developing chronic disease increases when hepatitis B is combined with hepatitis C infection.

Chronic hepatitis B infection has a higher risk for liver cancer than the rest of the population. The treatment is lifelong once it sets in. The same can be observed in hepatitis C infection. The only difference is that newer treatment aimed to cure hepatitis C has already been highly efficacious, reducing the risk of its chronic nature.

With treatment and management, the outlook of patients improves a lot, particularly in ensuring no severe liver damage occurs.

How Can People with Chronic Hepatitis Manage Their Condition?

If you want to live long and well even in the face of chronic hepatitis, it requires team collaboration. Important strategies include:

• Getting regular hepatitis panel and other blood tests for early detection and testing

• Having ultrasound scans to evaluate liver cancer periodically or as advised

• Avoid alcohol if you cannot abstain from it completely

• Only take prescribed medications

• Get vaccinated

Conclusion

With proper treatment and management, people with chronic hepatitis can lead, long and meaningful life. The infection or type of hepatitis virus will determine how severe it is. The manifestations can range from sub-clinical to more elaborate and seriously acute. In some cases, it will also lead to death (mortality).

Take control of your health, get tested with Ribbon Checkup today

Frequently Asked Questions

Which hepatitis has the highest mortality rate?

Hepatitis A has a mortality rate of just less than 1%

Hepatitis B causes hundreds or even thousands of death today

Hepatitis C has the highest mortality, particularly when it is chronic and left untreated

Can hepatitis be cured?

The answer is not all types. Hepatitis A and E are virtually self-limiting even without treatment. However, for infections with chronic hepatitis like B and C, prevention is better than looking for a cure.

Written by Jaclyn P. Leyson-Azuela, RMT, MD, MPH
Jaclyn P. Leyson-Azuela, RMT, MD, MPH, is a licensed General Practitioner and Public Health Expert. She currently serves as a physician in private practice, combining clinical care with her passion for preventive health and community wellness.

 

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